1. Conference Objectives To highlight the rising number of people living with HIV in Europe who are unaware of their serostatus To identify political, structural, clinical and social barriers to achieving optimal testing and counselling, and earlier care for HIV/AIDS To promote public health best practices and guidance found in Europe with regard to HIV testing, counselling and care

2. Delegate Attendance  More than 300 delegates attended the conference, invited from 53 countries of WHO Europe Region  The following countries were represented at the conference: Albania (1) Armenia (4) Austria (6) Azerbaijan (1) Belarus (2) Belgium (40) Bosnia and Herzegovina (2) Bulgaria (3) Croatia (2) Czech Republic (5) Denmark (20) Estonia (6) Finland (4) France (10) Georgia (1) Germany (19) Ghana (1) Greece (5) Hungary (2) Italy (12) Latvia (3) Lithuania (10) Luxembourg (2) Macedonia, the Former Yugoslav Republic of (4) Moldova, Republic of (1) Montenegro (1) Netherlands (15) Norway (2) Poland (9) Portugal (24) Romania (2) Russian Federation (4) Serbia (11) Serbia and Montenegro (2) Slovakia (Slovak Republic) (2) Slovenia (3) Spain (15) Sweden (11) Switzerland (9) Turkey (1) Ukraine (2) United Kingdom (29) United States (2) (faculty) Uzbekistan (1)

3. Barriers – Access to testing Patient related: Lack of perception of being at risk Lack of knowledge on testing possibilities Fear of positive results Concerns about lack of confidentiality (Eastern Europe) Fear of stigmatization Health system related: Populations marginalized and excluded (migrants) Geographic location

4. Barriers – Access to treatment and care Patient related: Concerns about lack of confidentiality (Eastern Europe Health System related: Medical facilities lacking Too few trained staff Geographic location Discrimination  Only 8 countries give universal access to ART  3 countries provide no access to migrants-documented or not, non nationals and non residents  Populations poorly covered for ART  Uninsured individuals (no access in 4 countries)  Undocumented migrants (no legal free access in 13 countries)

5. Social/Psychological Barriers Barriers and facilitators mostly located in individuals System characteristics are under-researched Focusing on socio-demographics/risk provides limited understanding. Explanations beyond description of obvious differences between communities Differences between sub-groups are small in well-adjusted communities Psychosocial factors contribute to the explanation of HIV-testing. Vulnerability may moderate the association between risk-taking and HIV testing Perceived benefits may exert more influence than perceived costs/barriers Lay perceptions of costs/benefits may be different from expert opinion. Perspective of those concerned needs to be taken into account Stigma and other social concerns seem crucial barriers. Those close to us rather than anonymous social context at large Promotion of testing needs to encompass fighting social stigma

6. Legal Barriers If we want to increase testing, or the offering of testing, we need to recognize that this may contribute indirectly to the criminalization of reckless HIV exposure and transmission Those who approve of criminalizing reckless exposure and transmission of HIV need to recognize that this may constitute a barrier to the goal of increased testing, especially among vulnerable populations HIV exposure and transmission MUST be seen through the lens of public health policy and NOT as a problem for which the criminal law can provide a solution

7. Conference Call to Action 1.Acknowledge that earlier diagnosis and care is urgently needed to improve the lives of people living with HIV and reduce transmission 2.Develop more precise estimates – size, characteristics, etc – of the undiagnosed population 3.Communicate the benefits of earlier care and reduce barriers to testing 4.Implement evidence-based testing and treatment guidelines in every country 5.Commit the necessary political, financial and human resources for their timely implementation Adopted by the European Parliament on 27 th November 2007